India’s healthcare in need of radical transformation

Despite considerable efforts being made in the health sector, a variety of structural weaknesses have led to a situation where India’s health system performance is unable to cope with the enormous demands placed on it

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Despite considerable efforts being made in the health sector, a variety of structural weaknesses have led to a situation where India’s health system performance is unable to cope with the enormous demands placed on it

Highlighting deficienes in India’s healthcare delivery system, a paper published in The Lancet called for a radical transformation in the architecture of healthcare if the country has to achieve the government’s vision of assuring health for all.

Authored by Professor Vikram Patel of Public Health Foundation of India and London School of Hygiene and Tropical Medicine colleagues, the paper said that healthcare costs in India are driving millions into poverty. Calling it the most disturbing indicator of the deficiencies of the Indian healthcare system, the authors argued not only for more resources, but for an integrated national healthcare system, built around a strong public primary care system with a clearly defined supportive role for the private and indigenous sectors, that addresses acute as well as chronic health care needs.

The paper records that despite considerable efforts being made in the health sector, with national and local governments investing in targeted disease control programmes and the National Health Mission focusing on maternal and child health, a variety of structural weaknesses have led to a situation where India’s health system performance is unable to cope with the enormous demands placed on it by the country’s growing population.

Significantly, according to the paper, India continues to lag behind regional neighbours, especially on health indicators like mortality rates for children aged under five years, recording 27 per cent of all neonatal deaths and 21 per cent of all child deaths in the world. Chronic nutrition deficiency manifesting as stunting continues to affect a third of children under five years.

According to Dr Vikram Patel, “The health time-bomb ticks on due to the rising burden of non-communicable diseases. Suicide is now a leading cause of death for young Indians, and an Indian is likely to suffer from a heart attack at least ten years earlier than in developed countries and yet the health care system has barely responded to these urgent health crises.”

Further, Dr Patel notes, there are “widespread inequities in health outcomes that are apparent in the large morbidity and mortality differentials across socioeconomic status, caste, class, sex, and geographic location.”

According to the experts, India’s current health system needs to correct its course that includes prioritising primary care and massively strengthening the country’s weak primary health system. “Despite an expansion and investment in primary health infrastructure through the National Rural Mission since 2005, there are wide disparities between and within states,” said the Lancet. According to the paper, “in 2011, in the high focus states, 60 per cent of the district hospitals did not offer intensive care services and nearly a quarter of these hospitals were struggling to cope with basic issues like drainage and sanitation.”

The challenge of availability of skilled human resources is another major issue mentioned by the experts. “At the beginning of the Twelfth Five Year Plan, barely 4 per cent of all doctors were working in the public sector in rural areas,” it further said.

The experts have also blamed the lack of regulation on private sector in healthcare for corruption across the sector. “India needs to better harness and regulate its large private sector — in 2014, more than 70 per cent of outpatient care and 60 per cent of inpatient care was provided in the private sector. However, lack of regulation has led to corruption across the sector, with consequent poor quality of care and impoverishment of patients,” it said.

The dismally low public spending on health, experts feel has crippled the public sector and created large barriers in quality and access.

As per the paper, the single biggest impediment to a holistic approach to health governance in the country is the lack of convergence between ministries related to health, water, sanitation, and national vertical targeted programmes. The authors argue that it is essential for the state to prioritise health as a fundamental public good, central to India’s developmental aspirations, at par with education.

The authors conclude, “In the immediate future, both the central and state governments should jointly launch a campaign to explain the principles and benefits of universal health coverage and engage with all concerned stakeholders in an atmosphere of a national mission. The role of communities and civil society is critical and they must be actively empowered to engage with this more radical vision of health care. To complement and, indeed, actively encourage the state governments to act towards making universal health coverage a people’s goal, a nationwide campaign will have to be led by civil society groups, along the lines of recent campaigns to combat corruption and sexual violence.”

“Delivering on its promise of assuring a healthy India should be the topmost priority of the Indian government...In the context of the enormous challenges and constraints faced by India’s health-care system, this goal might seem like wishful thinking. However, we believe that this goal is within reach provided there is the political will. Only a radical restructuring of India’s health care system will assure health care for all Indians, both improving its health indicators equitably and eliminating impoverishment due to health care, by the time the country reaches the milestone of 75 years of independence in 2022.”